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<br /> <br />c <br />K <br /> <br /> <br /> <br />n <br />a <br />C <br />a <br />z <br />a <br />n <br />m <br />GENDER: Otffe/IM~ hMn 1, T, 3 n1d 4. <br />Ptl1 V,OOr ~ Bs ~ "(iETWIN Td' ~Ok dM <br />rtAYfM i41R'. fgNn to AO ttik vAlt pfNrfttllkefRAhpAS.., <br />bYiffQ nturrlW t0 you.7M riHllrn Nc4Dt TYVrWI vOrld~ <br />Ydu~lg nMrhottMpl~On ANirMptoMAfINtlM~of , <br />IvuV. Fpr ~dOitidMl ~M a}OIIOw11pfMY1CKM~ <br />avaibbl~. CCllellft iDONttiarrK for frMr Mtl cheek twx(ae} <br />for service(s) requeetW. <br />t. ^ Show [o wricm, tlsn aed sdtlross of tlNivery. <br />2. ^ Rertrictetl Delivery. <br />3. Article A <br />ddr <br />MMtf <br />n: <br />, <br />~ <br />T <br />n _ n 4 .-- ^ . <br />~lJ~ '~~ <br />~a Ufa , CO 8)~ss <br />A. Type of Servioe: Article Nurnber <br />~ <br />~O~RegistareA o IinYreA <br />~ <br />C <br />ifi <br />d o C ~~ <br />D ~8 asa <br />P <br />.. <br />ert <br />e <br />DD <br />Express Mail <br />^ <br />Always obtain St9fletUre of addraseeyragent aftd <br />DATE DELIVERED. <br />5. i eslee <br /> <br />6. Signature - Agent <br />x <br />~. Date of ONivery <br />8. AddresseB't Adtlren ~ I <br />~ P 068 282 755 <br />l <br />!~ RECEIPT FOR CERTIFIED MAIL <br />Q t NO INSURANCE COVERAGE PROVIDED <br />fJ £ NOT FOR INTERNATIONAL MAIL <br />~~~ (See Reverse) <br />p~ m <br />r O <br />6 <br />O <br />ei <br />w ~ <br />t <br />m <br />VJ ~ <br />MLL <br />~ o <br />E <br />IL <br />LJ a <br />Sent to <br />.z` 0-+4o G <br />Street d No. <br />, <br />P.O., St IB antl Z P Cotle ~ Lpss <br />Postage S <br />Ceniflatl Fee _ ' <br />Special Delivery Fee •~~~i <br />{Y <br />Restricted Deliverx'fee^ <br />C..;. <br />Return Recei wing <,~ <br />to whom an to Deliver <br />Retum r pt • howing [~.yih m, y~ <br />Data, ress of ery <br />TOT rage a ~ <br />. S_~`x' <br />~_ <br />r, <br />Postm rk or te) <br />Tja .°• <br />` <br />n i~ <br />~1 <br />^~ / <br />~~' <br />' <br />~'~._ <br />L <br /> <br />